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Can you help me understand
I have microhematuria. I had a local uro do a cysto and he BXed a red spot in my bladder. The BX was destroyed in processing. And so, I decided to go to a pro – Dr Harry Herr at Sloan Kettering. Dr. Herr did a cysto with and without NBI technology. NBI is a technology that is supposedly better than white light (WL) technology. He did a cytology and a CT urogram. All were negative. Dr. Herr was unimpressed enough by his inspection of my bladder that he didnt even feel that it warranted a superficial BX. This was in June and I am due back for another cysto and cytol in Dec. I left feeling that I was in the clear, ie, I was feeling that the combination of the three tests ruled out cancer to the tune of about 99%. However, lately I have been hearing that cystoscopy can miss BC as much as 30% of the time. However, this stat is supposedly for the WL cysto. I also have been hearing that cytology is pretty awful at detecting cancer – it misses alot. However, those bashing cytology seem to be pushing NMB22 and may be associated financially with the company that makes the test.
Can someone set me straight on this? Does any know how sensitive cystoscopy and cytology really are? Is NMB22 really better than cytology? Does it have more false positives than cytology?
Also, can someone explain to me how to send a private message? I wanted to try to contact Pat?
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6 Replies
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From what I see here, Mike is right, specimen did not survive processing so no one knows what was there at the time of the initial biopsy. As to NMP-22, cytology and cystoscopy; cystoscopy is the gold standard for diagnosis of bc. There are false negatives, but I doubt as high as 30% unless the study group is limited to only certain categories of patients. Cytology is quite good with high grade lesions, perhaps better than any of the surrogate tests (such as NMP and others), but is not as good with low grade lesions. The specificity of cytology is better than the surrogate tests (meaning that a positive is more likely to be bc in the case of positive cytology than positive surrogate (such as NMP). Nmp false positives seem to be higher in cases of bladder inflammation. I also believe that adding the fluorescent aspect to cystoscopy greatly improves its sensitivity (ability to detect lesions) particularly for CIS. Best wishes,
jj
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The initial post said that the sample was destroyed before there person when to the Herr. Maybe I misinterpreted but I’m not sure how Herr can find anything if he’s not given anything to look at.
If there was CIS but it was destroyed and there was no pathology to analyze, and if the there isn’t any visible CIS still in the bladder, then I would guess that Herr would want to be on the safe side and therefore set up a surveillance schedule to keep an eye on things.
Maybe there were slides, but the message didn’t indicate that…
Mike
Age 54
10/31/06 dx CIS (TisG3) non-invasive (at 47)
9/19/08 TURB/TUIP dx Invasive T2G3
10/8/08 RC neobladder(at 49)
2/15/13 T4G3N3M1 distant metastases(at 53)
9/2013 finished chemo -cancer free again
1/2014 ct scan results….distant mets
2/2014 ct result…spread to liver, kidneys, and lymph system
My opinions are my own and do not reflect the opinion of ABLCS or anyone else. I am not a doctor nor do I play one on TV.
Just wanted to chime in with Pat’s observation of microhematuria. I personally have 2 friends that no known causation. They have had it off and on for 20+ years. So it’s not unusual-just not common.
DX 5/6/2008 TAG3 papillary tumor .5 CM in size. 2 TURBS followed by 6 instillations of BCG weekly with a second round of 6 after a 6 week wait.Believe me if it were CIS Herr would have caught it from the margins or even from the destroyed slides. He caught mine and completely excised it. He’s pretty much a genius.
pat
Osiag,
It may have ruled out residual cancer but who knows about the original issue? It could have been CIS, which has a high recurrence rate so you want to be on monitoring. I’m not sure how they could rule out bladder cancer given the red spot could have been CIS but was destroyed prior to pathology analysis.
I know about NMP-22. They did both cytology and NMP-22 tests on my urine. Pat can probably point you to the research on which is better.
The blue light is supposed to be much better than the white light at seeing things.
To send a PM to Pat, go to one of her posts. Under the picture it says whether a person is online or offline, then has a small box with “PM” in it, the a longer box with “Profile”. Click on the PM box. It takes you to the message screen. Once you type your message in, there is small box underneath the character count box on the left hand side. Under that is a box that has the word “Send” in it. It is pretty much invisible though because it is black type on dark blue background. You’ll find it though.
Mike
Age 54
10/31/06 dx CIS (TisG3) non-invasive (at 47)
9/19/08 TURB/TUIP dx Invasive T2G3
10/8/08 RC neobladder(at 49)
2/15/13 T4G3N3M1 distant metastases(at 53)
9/2013 finished chemo -cancer free again
1/2014 ct scan results….distant mets
2/2014 ct result…spread to liver, kidneys, and lymph system
My opinions are my own and do not reflect the opinion of ABLCS or anyone else. I am not a doctor nor do I play one on TV.osiag…..well you got the premier Bladder cancer specialist…he got all of mine out plus margins and with white light…i would be very surprised if he missed something especially using the newer technology.plus he did a urogram which would wash out any stray cells. Its good that he’s going to follow through in December. Microhematuria can happen in some cases and they never find the cause. It happens a lot with runners, people who exercise heavily…..or for no particular reason. I think you’re in good hands.
if you want to send a private message just hit the PM under my name and voila!!
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